Pleural effusion is a condition characterized by the abnormal accumulation of fluid in the space between the layers of tissue that line the lungs and chest cavity. This excess fluid can put pressure on the lungs, leading to shortness of breath and difficulty breathing.

In this article, we will discuss the causes, symptoms, and treatment options for a pleural effusion. We also included helpful practice questions on this topic.

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What is a Pleural Effusion?

The pleura is a thin membrane that surrounds and provides protection to the lungs. The space between this membrane and the lungs is known as the pleural space.

An abnormal accumulation of fluid in the pleural space is known as a pleural effusion, which has specific causes, symptoms, and treatment methods.

Types

There are two types of pleural effusions:

  1. Transudative
  2. Exudative

Transudative pleural effusions occur due to increased pressure in blood vessels that cause leaking into the pleural space. They often result from congestive heart failure, cirrhosis, or coronary heart disease.

Exudative pleural effusions occur due to inflammation or infection. This results in excess fluid production and reduced drainage.

Causes

There are a variety of processes that can lead to the development of a pleural effusion, including:

  • Congestive heart failure
  • Cirrhosis
  • Kidney failure
  • Lung infections
  • Autoimmune diseases
  • Lung cancer
  • Chest trauma
  • Certain medications

While multiple conditions can cause a pleural effusion, CHF is the most common cause.

pleural effusion thoracentesis

Treatment

The treatment method for a pleura effusion depends on the specific cause. However, some common examples include:

  • Chest tube insertion
  • Thoracentesis
  • Diuretic medications
  • Antibiotic medications
  • Pleurodesis
  • Surgery (in severe cases)

Each patient may require one or more of these treatments depending on the severity of their signs and symptoms.

Pleural Effusion Practice Questions:

1. What is an abnormal accumulation of fluid in the pleural cavity?
Pleural effusion

2. What causes fluid accumulation from a pleural effusion?
The imbalance between fluid formation and absorption

3. What are the types of pleural effusions?
Transudative and exudative

4. What happens with a transudative pleural effusion?
Increased hydrostatic pressure, decreased oncotic pressure, low protein, low specific gravity, and a low cell count

5. What happens with an exudative pleural effusion?
Increased permeability, high-protein, high specific gravity, high cell count, and increased WBCs

6. Which type of pleural effusion causes an increased hydrostatic pressure?
Transudative

7. What are the clinical features of a pleural effusion?
Pleuritic chest pain and dyspnea

8. What physical finding varies in pleural effusions?
The amount of fluid that is present

9. What happens to chest expansion when a pleural effusion is present?
It decreases

10. How is the percussion note for a pleural effusion?
Dull

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11. What happens to fremitus when a pleural effusion is present?
It is decreased or absent.

12. How are breath sounds with a pleural effusion?
They are absent over the affected area.

13. What happens to the mediastinum when a pleural effusion is present?
There will be a mediastinal shift towards the unaffected side.

14. What is used for the diagnosis of a pleural effusion?
Chest x-ray

15. What sign on a chest x-ray helps with the diagnosis of a pleural effusion?
Blunting of the costophrenic angles

16. What type of x-ray is needed for a small pleural effusion?
Lateral decubitus

17. What are the causes of a transudative pleural effusion?
CHF, cirrhosis, and kidney disease

18. What are the causes of an exudative pleural effusion?
Infection, neoplasms, pulmonary embolism, surgery, systemic disease, and intra-abdominal disease

19. How can you diagnose a pleural effusion as either transudative or exudative?
Thoracentesis

20. When is pleurodesis indicated?
When the underlying disease is not treatable

21. What additional signs and symptoms may be present with empyema?
Fever and other signs of an infection

22. What is the respiratory therapist’s role in treating a pleural effusion?
Provide supplemental oxygen

23. Is CPT used to treat a pleural effusion?
No, CPT should not be used.

24. How to treat a pleural effusion?
The most common treatment methods for a pleural effusion are chest tube insertion and thoracentesis. However, depending on the severity of the condition, a patient may require additional treatments such as diuretic medications, antibiotic medications, or surgery.

25. What is a malignant pleural effusion?
A malignant pleural effusion is an accumulation of fluid in the pleural space that is caused by the spread of cancer.

26. What is the survival rate of those with a malignant pleural effusion?
The survival rate of those with a malignant pleural effusion depends on the type and stage of cancer.

27. A diagnosis of exudative pleural effusion would be based on what?
Pleural fluid protein/serum protein ratio >0.5

28. Why is a right-sided pleural effusion more common in heart failure?
The right side of the heart is responsible for pumping blood to the lungs. When this process is not working properly, fluid can leak into the pleural space.

29. What is the difference between pleurisy and pleural effusion?
Pleurisy is inflammation of the pleura, while pleural effusion is an accumulation of fluid in the pleural space.

30. What is the difference between pulmonary edema and pleural effusion?
Pulmonary edema is fluid accumulation in the air spaces of the lungs, while pleural effusion is fluid accumulation in the pleural space.

31. What is the incidence of a pleural effusion in the United States?
It is estimated that 1.5 million Americans develop a pleural effusion each year.

32. What is the mortality rate of a pleural effusion in cancer patients?
Pleural effusion in cancer patients is associated with significant mortality and morbidity, with a median survival of three to twelve months.

33. Transudative pleural effusions are often caused by what?
Abnormal lung pressure

34. Exudative pleural effusions form as a result of what?
Inflammation of the pleura that is often caused by a lung disease

35. What is the difference between a hemothorax and pleural effusion?
A hemothorax is a collection of blood in the pleural space, while a pleural effusion is an accumulation of fluid in the pleural space.

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36. How does a pleural effusion show up in an imaging study?
It shows up as densities with blunted costophrenic angles.

37. Which view best shows the amount of fluid in the lungs?
Lateral decubitus

38. Which lung condition most often requires treatment with a thoracentesis?
Pleural effusion

39. Which way does the trachea shift when a pleural effusion is present?
It shifts away from the affected side.

40. What other imaging technique can be used to find a pleural effusion?
Ultrasound

41. Which type of pleural fluid is associated with CHF?
Transudate

42. Which type of pleural fluid is associated with empyema?
Exudate

43. What common lung infection can lead to pleural effusion?
Pneumonia

44. When is a dull percussion note heard?
Over areas of fluid and consolidation

45. How does the area of pleural effusion appear on a chest x-ray?
The affected area is solid and white.

46. Which way does the mediastinum shift when a pleural effusion is present?
To the unaffected side

47. Which type of pleural effusion is a radiographic sign of heart failure?
Bilateral pleural effusions

48. What commonly occurs adjacent to pleural effusions after abdominal or thoracic surgery?
Atelectasis

49. What are the signs of long-standing heart failure on a chest x-ray?
Cardiac enlargement and bilateral pleural effusions

50. Are pleural effusions common in patients with pneumonia?
Yes, they are common in patients with bacterial pneumonia; however, they are uncommon in patients with viral or fungal pneumonia.

Final Thoughts

Pleural effusion is a common condition that must be treated with the help of doctors, nurses, and respiratory therapists. That is why it’s recommended to develop an understanding of the types, causes, and symptoms.

Hopefully, this guide can make the learning process easier for you. We have a similar guide about the other pleural diseases that I think you’ll find helpful. Thanks for reading!

Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.

References

The following are the sources that were used while doing research for this article:

  • Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
  • Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
  • Krishna, Rachana, and Mohan Rudrappa. “Pleural Effusion.” National Library of Medicine, 11 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK448189.
  • Jany, Berthold, et al. “Pleural Effusion in Adults—Etiology, Diagnosis, and Treatment.” National Library of Medicine, Dtsch Arztebl Int, May 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6647819.
  • Karkhanis, Vinaya S., and Jyotsna M. Joshi. “Pleural Effusion: Diagnosis, Treatment, and Management.” National Library of Medicine, Open Access Emerg Med, 22 June 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC4753987.